- Prime Healthcare (Lynwood, CA)
- …education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/185693/ case - manager utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care… more
- Dignity Health (Northridge, CA)
- …dignityhealth.org/northridgehospital (https://www.dignityhealth.org/socal/locations/northridgehospital) for more information. RN Case Manager (Care Coordinator) ... pertaining to their practice. + Have an understanding of Utilization Review to progress plan of care....a clinical or insurance setting is required. + Certified Case Manager (CCM), Accredited Case … more
- Molina Healthcare (Long Beach, CA)
- …Interqual criteria **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina ... employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay… more
- Deloitte (Costa Mesa, CA)
- …the C-Suite. Our services extend beyond HR to include the CEO, CFO, Risk Manager , and Business Unit leaders, delivering value and creating impact for our clients. ... client expectations and working with leading global businesses? Your RoleAs a Manager in Employer Health, you will provide strategic and technical employee benefit… more
- Dignity Health (Long Beach, CA)
- …+ AHA BLS card + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to apply clinical guidelines to ensure ... multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate....least five (5) years of nursing experience. + Certified Case Manager (CCM) Accredited Case … more
- Elevance Health (Cerritos, CA)
- …mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests involving radiology imaging ... clinical criteria and relevant Carelon Medical Benefits Management policies pertaining to utilization review . + Demonstrate and maintain knowledge of applicable… more
- Elevance Health (Cerritos, CA)
- …Health PulsePoint locations. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of high-tech diagnostic ... Demonstrate and maintain knowledge of relevant policies and regulations pertaining to utilization review of diagnostic imaging procedures, cardiac services and… more
- Elevance Health (Costa Mesa, CA)
- …or equivalent. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted RN license ... May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or...more junior Clinicians. Approval decisions may be subject to review by more senior nurses or Medical Director. Primary… more
- J&J Family of Companies (Irvine, CA)
- …(Learned Intermediary) is responsible for providing effective and efficient contract review and negotiation for commercial contracts. This individual will be ... Lead Analyst, Contract Management will work closely with the Sr. Manager , Contract Management, Director, Customer Operations, Corporate Accounts Managers, and… more
- Elevance Health (Costa Mesa, CA)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... position. The Med Mgmt Nurse CA is responsible for review of the most complex or challenging cases that...skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has… more
- Griffith Company (Los Angeles County, CA)
- …methods and sequence of operations. + Coordinate manpower and equipment utilization . + Assist project manager in conducting effective ... Review job costs and budget controls with project manager /foreman. + Monitor processing of timesheet and extra work...to candidates outside of the local area on a case -by- case basis. Visit us at: www.griffithcompany.net. Griffith… more
- Elevance Health (Costa Mesa, CA)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- Elevance Health (Cerritos, CA)
- …based guidelines, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of sleep studies, durable medical equipment, high-tech ... to work in a dynamic, fast-paced environment. + Preferred interest in Sleep management utilization review . For candidates working in person or remotely in the… more